Diagnosis, epidemiology, clinical course, treatment, and cost effectiveness of treatment for dissociative disorders and MPD: report submitted to the Clinton administration task force on health care financing reform

p. 003-011.Dissociative disorders are highly prevalent mental disorders in North America with a reported prevalence of about ten per cent in the general population. The prevalence of these disorders is related to the prevalence of trauma in the general population. Multiple personality disorder (MPD) is a severe chronic mental disorder that affects about one per cent of the general population in North America and is associated with an early childhood history of severe trauma, primarily multiple forms of abuse before the age of five. MPD patients are already present in the mental health treatment system in substantial numbers. MPD patients commonly average 6 to 12 years in unproductive treatment and/or social welfare systems prior to correct diagnosis. There is evidence of considerable treatment efficacy for an intensive form of psychotherapy for MPD. Further, there is evidence for cost effectiveness of treatment of MPD with substantial savings once correct treatment is initiated. Despite this, there appear to be subgroups of MPD patients with one patient group showing rapid resolution of all dissociative psychopathology and another group showing more chronicity. The latter group does achieve cost effectiveness for treatment, but at a slower rate. One major variable in discriminating these groups was the length of time in the mental health treatment system before correct diagnosis with the more slowly responsive group having a much longer chronic treatment career prior to correct diagnosis